Healthcare Provider Details

I. General information

NPI: 1316207962
Provider Name (Legal Business Name): ANTONIA FRANCIS OLADIPO MD, MSCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTONIA FRANCIS KIM MD, MSCI

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/11/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE # 2W-73
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

327 4TH STREET UNIT A
PALISADES PARK NJ
07650-2201
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2453
  • Fax:
Mailing address:
  • Phone: 347-249-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number284384
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number25MA10586900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: